NICE moves to improve bowel disorder diagnoses

The National Institute for Health and Care Excellence has published draft guidance which it hopes will help improve the diagnosis of serious bowel conditions.

The preliminary guidelines advise that doctors should use one simple stool test in order to reduce the number of incorrect diagnoses and thereby get patients faster treatment for their bowel disorders.

Irritable Bowel Syndrome (IBS) is an unexplained disorder that primarily affects younger people aged between 20 and 30 years. While there is no clear cause, it is widely accepted that bouts may be triggered by diet or stress. No definitive treatment exists for the condition, which, while potentially interfering with some aspects of daily life, does not usually have serious consequences.

On the other hand, Inflammatory Bowel Disease (IBD), which refers to a group of conditions such as Crohn’s disease and ulcerative colitis, can have serious complications, including a high risk of requiring surgery and an increased risk of colorectal cancer, underscoring the need to identify these patients as early as possible in order to administer the appropriate treatment.

According to NICE, greater use of the faecal calprotectin test will better distinguish between cases of IBS and the more serious IBD, because it detects a protein found in inflammatory cells which is present in the stool in higher numbers when the bowel is inflamed.

A number of tests are currently used in practice in both primary and secondary care, but the focus ruling out conditions rather than diagnosing one.

Uncertainty and procedures

"This means people often face uncertainty, lots of visits to hospitals and their GP and repeated tests – some of them invasive and uncomfortable," said Professor Carole Longson, Director of the NICE Health Technology Evaluation Centre, adding that "many people with IBD, particularly children with Crohn’s Disease, sometimes have to wait for several years for confirmation of their condition".

After looking at the available evidence on 12 tests, NICE found that faecal calprotectin testing is "a good way to distinguish between IBS and IBD". Moreover, "as well as being of benefit to patients, the tests will also save the NHS money", by reducing the time spent on reaching diagnosis and the number of invasive procedures used to do so, she said.

This could also alleviate pressure on colonoscopy departments, thus allowing a greater focus on those who are thought to have more serious conditions such as bowel cancer, the Institute noted.